Asthma Treatments in Pregnancy
Key point
Uncontrolled asthma and maternal hypoxemia are associated with adverse pregnancy outcomes.
Maintain control using guideline-based step therapy; do not step down in pregnancy unless clearly stable.
THE PRESCRIBING PHYSICIAN MUST BE FAMILIAR WITH THE FULL PRODUCT LABELING AND RELEVANT MEDICAL LITERATURE PRIOR TO USE.
Quick index
- Relievers: Albuterol • Levalbuterol • Ipratropium
- Controllers (ICS): Budesonide • Fluticasone • Beclomethasone • Mometasone • Ciclesonide
- ICS/LABA: Symbicort • Advair • Dulera • Breo • AirDuo
- Other controllers: Montelukast
- Systemic steroids: Prednisone/Prednisolone • Methylprednisolone (Solu-Medrol)
- Adjuncts in severe exacerbation: Magnesium sulfate (IV) • Terbutaline (selected) • Epinephrine (anaphylaxis)
- Severe asthma biologics: Omalizumab • Dupilumab • others
Relievers
Albuterol (Salbutamol)
First-line reliever Renal: none
How administered
Inhalation via MDI (prefer spacer) or nebulization.
Typical dosing (examples)
- MDI: 90 mcg/puff; 2 puffs q4–6h PRN.
- Exacerbation: 2–4 puffs q20 min × 3 doses, reassess.
- Neb: 2.5 mg in 3 mL NS q4–6h PRN (higher/frequent per protocol in severe attacks).
How supplied
HFA inhalers; nebulizer solution vials/ampules (product dependent).
Manufacturer labeling
Pregnancy notes
Most commonly used reliever in pregnancy; compatible when indicated.
Levalbuterol
Alternative reliever
How administered
Inhalation via MDI or nebulization.
Typical dosing (examples)
- MDI: 45 mcg/puff; 2 puffs q4–6h PRN (label/protocol dependent).
- Neb: commonly 0.63–1.25 mg q6–8h PRN (severity/protocol dependent).
How supplied
HFA inhaler; nebulizer solution (various strengths).
Manufacturer labeling
Pregnancy notes
Use when clinically appropriate; albuterol remains standard first-choice in many protocols.
Ipratropium bromide (SAMA)
Adjunct in exacerbation Often combined with albuterol in moderate–severe attacks.
How administered
Inhalation (MDI or nebulization).
Typical dosing (examples)
- MDI: 2 puffs (17 mcg/puff) q6h–q8h (protocol dependent).
- Neb: 0.5 mg q20 min × 3 doses in ED protocols, then reassess (often with albuterol).
How supplied
MDI; nebulizer solution vials.
Manufacturer labeling
Pregnancy notes
Used as add-on in exacerbations; limited systemic absorption via inhaled route.
Controllers: Inhaled Corticosteroids (ICS)
Controller therapy
ICS are the preferred maintenance therapy for persistent asthma in pregnancy. If controlled on a non-budesonide ICS prior to pregnancy,
many guidelines favor continuing the same effective regimen rather than switching solely due to pregnancy.
Budesonide
Preferred ICS Largest pregnancy safety experience.
How administered
Inhalation (DPI) or nebulized suspension.
Typical dosing (examples)
- Low: 200–400 mcg/day
- Medium: 400–800 mcg/day
- High: >800 mcg/day
How supplied
Pulmicort Flexhaler® (DPI); Pulmicort Respules® (neb).
Manufacturer labeling
Pregnancy notes
Use lowest effective ICS dose to maintain control.
Fluticasone (propionate / furoate)
Common alternative ICS
How administered
Inhalation (MDI or DPI depending on product).
How supplied
Flovent® (propionate) MDI/DPI (availability varies); Arnuity® Ellipta (furoate).
Manufacturer labeling
Pregnancy notes
Continue if already effective prior to pregnancy; avoid unnecessary switching.
Beclomethasone
Alternative ICS
How supplied
QVAR RediHaler® (beclomethasone dipropionate HFA).
Manufacturer labeling
Pregnancy notes
Acceptable ICS option when needed for control.
Mometasone
Alternative ICS
How supplied
Asmanex® Twisthaler / HFA (product dependent).
Manufacturer labeling
Pregnancy notes
Reasonable option; prioritize regimen that maintains control.
Ciclesonide
Alternative ICS
How supplied
Alvesco® HFA inhaler.
Manufacturer labeling
Pregnancy notes
Acceptable alternative if effective and available.
ICS/LABA (controller step-up)
Budesonide–Formoterol (Symbicort®)
Common step-up LABA should be used with ICS.
How administered
Inhalation (MDI).
Typical dosing (example)
- 160/4.5 mcg: 2 inhalations twice daily (example)
How supplied
Combination inhaler (multiple strengths).
Manufacturer labeling
Pregnancy notes
Use when needed to maintain control; continue effective pre-pregnancy regimen.
Fluticasone–Salmeterol (Advair®)
Common step-up
How supplied
Diskus DPI and/or HFA (product dependent).
Manufacturer labeling
Pregnancy notes
Acceptable when required for control; do not stop LABA/ICS if it maintains stability.
Mometasone–Formoterol (Dulera®)
Alternative ICS/LABA
How supplied
MDI inhaler.
Manufacturer labeling
Pregnancy notes
Use when appropriate; prioritize regimen that maintains control.
Fluticasone furoate–Vilanterol (Breo® Ellipta)
Once-daily option
How supplied
Ellipta DPI.
Manufacturer labeling
Pregnancy notes
Consider for adherence/once-daily needs if already effective and available.
Fluticasone–Salmeterol (AirDuo® Digihaler / RespiClick)
Alternative fluticasone/salmeterol
How supplied
DPI devices (product dependent).
Manufacturer labeling
Pregnancy notes
As above; continue effective ICS/LABA rather than stepping down.
Other controller options
Montelukast (Singulair®)
Adjunct/alternative
How administered
Oral.
Typical dosing
10 mg PO once daily (evening typical).
How supplied
Tablets; chewable tablets; oral granules (product dependent).
Manufacturer labeling
Pregnancy notes
Often continued if it contributed to good pre-pregnancy control.
Systemic corticosteroids
Prednisone / Prednisolone (oral)
Exacerbations Use when indicated; untreated exacerbation is higher risk.
How administered
Oral.
Typical dosing (examples)
- “Burst”: 40–60 mg/day for 3–10 days (protocol dependent).
How supplied
Tablets; oral solution (various strengths).
Labeling
Generic multiple manufacturers; verify local formulary labeling.
Pregnancy notes
Short courses acceptable when clinically indicated.
Methylprednisolone (Solu-Medrol®) — IV
Severe exacerbation Common ED/L&D/ICU steroid for moderate–severe attacks.
How administered
IV push/IV infusion per institutional protocol.
Typical dosing (examples)
- Severe exacerbation: 60–80 mg IV q6–12h initially (institutional protocols vary), then transition to oral as improving.
Dose/interval should follow ED/ICU protocol and patient response.
How supplied
Vials (powder for reconstitution) and/or injectable formulations (product dependent).
Manufacturer labeling
Pfizer labeling portal
(search “Solu-Medrol”)
Pregnancy notes
Use when clinically indicated for severe exacerbation; maternal oxygenation is priority.
Adjuncts in severe exacerbation (selected)
Magnesium sulfate — IV
Adjunct Consider in severe exacerbations not responding to initial bronchodilators/steroids.
How administered
IV infusion.
Typical dosing (example)
- 1.2–2 g IV over ~20 minutes (common ED protocol range)
How supplied
IV vials/ampules; concentration varies.
Pregnancy notes
Widely used in obstetrics for other indications; monitor for hypotension/flushing; adjust for renal impairment.
Epinephrine
Anaphylaxis Not an asthma controller; lifesaving in anaphylaxis with bronchospasm.
How administered
IM (anaphylaxis) per standard protocols.
Pregnancy notes
Do not withhold epinephrine in anaphylaxis due to pregnancy.
Severe asthma biologics (specialist managed)
Biologics
Consider continuing in select patients already well-controlled prior to pregnancy after shared decision-making with pulmonology/allergy–immunology and MFM.
Data are evolving; prioritize maternal stability.
Omalizumab (Xolair®)
Anti-IgE
How administered
Subcutaneous injection (clinic/home depending on protocol).
How supplied
Prefilled syringes and/or vials (product dependent).
Manufacturer labeling
Pregnancy notes
Most pregnancy experience among asthma biologics; continue case-by-case if benefit is high.
Dupilumab (Dupixent®)
Anti–IL-4Rα
How supplied
Prefilled syringes/pens.
Manufacturer labeling
Pregnancy notes
Evolving data; decisions individualized with specialist team.
Other biologics (specialist use)
Anti-IL-5 / Anti-TSLP Examples: mepolizumab (Nucala®), benralizumab (Fasenra®), reslizumab (Cinqair®), tezepelumab (Tezspire®).
Practical monitoring
Review inhaler technique and adherence frequently, assess reliever use, night symptoms, and activity limitation at each prenatal visit,
and provide a written asthma action plan.
UPDATED: 12/18/2025
References (click to expand)
- Global Initiative for Asthma (GINA). Global Strategy for Asthma Management and Prevention. (Most recent update).
- NAEPP Coordinating Committee. 2020 Focused Updates to the Asthma Management Guidelines. J Allergy Clin Immunol. 2020.
- Key reviews on asthma in pregnancy and perinatal outcomes (e.g., Namazy/Schatz; meta-analyses on uncontrolled asthma risks).
- NHLBI. Managing Asthma During Pregnancy (classic guidance; still widely cited for principles of therapy).
- Manufacturer prescribing information / package inserts: Ventolin, Xopenex, Atrovent, Pulmicort, Symbicort, Advair, Dulera, Breo, AirDuo, Singulair, Xolair, Dupixent, Nucala, Fasenra, Cinqair, Tezspire.
Always verify dosing and indications with current labeling and local protocols; adjust for severity, comorbidities, and renal/hepatic function as appropriate.